Employer Attestation. The Employer must review and complete Exhibit B upon entering into this Agreement.
Employer Attestation. On behalf of the Employer named below, I hereby attest and warrant that the Employees listed in Exhibit A are Full-time Non-bargained Employees as defined in the Subscriber Agreement between the Employer and the Plan. I further attest that I have reviewed and am familiar with the various participation requirements set forth in the Subscriber Agreement and FAQ, including, but not limited to, the following: contribution requirements, due date, audit, definition of Full-time Non-bargained Employee, requirement that all Full-time Non-bargained Employees working in the geographic jurisdiction of District Council 16 are required to participate (no Employee opt-out), renewal and termination. I understand that the Plan relies upon these representations and the Employer shall be liable for any misrepresentations with respect to the provisions of the Subscriber Agreement.
Employer Attestation. On behalf of the Employer named below, I hereby attest and warrant that the Employees listed are full-time non-bargained Employees as defined in the Subscriber Agreement between the Employer and the District Council 16 Northern California Health and Welfare Trust Fund. I further attest that I have reviewed and am familiar with the various participation requirements set forth in said Subscriber Agreement and Exhibits A - C, including, but not limited to, the following: contribution requirements, due date, audit, definition of full-time non-bargained Employee, requirement that all full-time non-bargained Employees working in the geographic jurisdiction of the District Council 16 Northern California Health and Welfare Trust Fund are required to participate (no Employee opt-out), termination and renewal. I will ensure that a completed Exhibit A is submitted to the Fund Office on an annual basis and a completed Exhibit C is submitted to the Fund Office on behalf of each employee covered under this Subscriber Agreement. I understand that the District Council 16 Northern California Health and Welfare Trust Fund relies upon these representations and the Employer shall be liable for any misrepresentations in accordance with the provisions of the Subscriber Agreement and Exhibits A - C. I certify that I am a responsible officer or owner of the above-referenced Employer and am authorized to make this Employer Attestation. [Name of Employer] [Date] [Print Name & Title] [Signature] EXHIBIT C DISTRICT COUNCIL 16 NORTHERN CALIFORNIA HEALTH AND WELFARE TRUST FUND SUBSCRIBER AGREEMENT FOR NON-BARGAINING EMPLOYEES OF SIGNATORY EMPLOYERS Employee Attestation ELIGIBILITY: I understand that I must be a non-bargained full-time employee of an employer with bargained employees under a collective bargaining agreement with District Council 16, International Union of Painters and Allied Trades, regularly scheduled to work at least 30 hours per week on average for the year. If I am a bargained employee, I understand that I am not eligible for coverage under the Subscriber Agreement. CONTRIBUTION: I authorize my employer to deduct the requested contribution, if any, from my earnings. BENEFIT AVAILABILITY: I understand that my benefits under this Plan begin with a specific effective date that will not begin until the 1st day of the month following two (2) consecutive months in which I am regularly scheduled to work at least 30 hours per week, provided that the Fund has received a full ...
Employer Attestation. On behalf of the Employer named below, I hereby attest and warrant that the Employee(s) listed in Exhibit A are Alumni as defined in the Subscriber Agreement between the Employer and the Plan. I further attest that I have reviewed and am familiar with the various participation requirements set forth in the Subscriber Agreement and FAQ, including, but not limited to, the following: contribution requirements, due date, audit, definition of Alumni, renewal and termination. I understand that the Plan relies upon these representations and the Employer shall be liable for any misrepresentations with respect to the provisions of the Subscriber Agreement.
